Approved form AF2002-238

Approved by the General Manager of the Health Protection Service on 6.12.2002 under the

Public Health Act 1997, s137A

Public Health Act 1997—Form DW2
(see s31)
Australian Capital Territory

Drinking Water Utility Activity Licence

(See attached Drinking Water Utility Activity Licence)

Drinking Water Utility Licence
«Trading_Name»
ABN: «Proprietor_ABN»
«Premises_PropertyName»
«Premises_StreetNo» «Premises_Street»
«Premises_Suburb»  «Premises_Postcode»
Registration No: «Registration_Number»
This licence authorises «Proprietor_FullName», of the above address, to carry on the Operation of a Drinking Water Utility under the Public Health Act 1997 for the period starting from {{Date_Granted}} to «Due_for_Renewal».
Standard Conditions
1.	This licence remains in force until the date of expiry unless suspended, surrendered or cancelled, or the above mentioned licensee ceases to be the occupier of the premises.
2. 	The licensee is to comply with the Drinking Water Quality Code of Practice.
3. 	The licensee is to add fluoride to the drinking water network at a concentration not exceeding 1.0mg / L ±0.2 mg / L.
Special Conditions
«Conditions»

<Signatory>